EMEU-4005 - Emergency Medicine Point-of-Care Ultrasound -4th Year (4-week Elective)

EMEU-4005 - Emergency Medicine Point-of-Care Ultrasound -4th Year (4-week Elective)

Elective Title: Emergency Medicine Point-of-Care Ultrasound -4th Year (4-week Elective)
Course Number: EMEU-4005
Elective Type: clinical Duration/Weeks: 4 Max Enrollment: 2
Prerequisites: Successful completion of Year 3
Additional Requirements: Would like to give preferences to the EM med students during months of July-September.
Responsible Faculty Director: Jeremy Carter, DO Periods Offered: 1-13 including holiday period 8 
Coordinator: Vanessa Phillips Other Faculty: Paul Koscumb, MD
Location to Report on First Day:
UTMB Galveston Emergency Department Conference Room (email Vanessa Phillips @ valphill@utmb.edu for additional information)

This course will provide a broad introduction to point-of-care-ultrasound consisting of lectures and hands on scanning with ultrasound fellowship trained emergency physicians. Fourth year medical student curriculum would focus on differentiating sonographic normal from pathology and learning how Point-of-care ultrasound can be implemented into patient care.

Each student should be able to perform 60 ultrasounds during the elective. Each student will give a 15 to 20 minute presentation on a POCUS subject of their choice.

Description of course activities
The curriculum will consist of at home online lectures, 18 to 20 scanning shifts, and four image review sessions. During one of the image review sessions each student will be required to present on a POCUS topic of their choice. Each presentation will be about 10 to 15 minutes. The students will receive lecture and hands on training for a variety of applications, which are listed below.
1. Physics/Instrumentation
2. Biliary
3. Renal
4. Aorta
6. Cardiac
7. Procedures (emphasis on ultrasound guided peripheral access/ultrasound guided regional anesthesia)
8. Pelvic/Obstetrical Ultrasound
9. Deep Venous Thrombosis
10. Skin/Soft Tissue/Musculoskeletal

Additional emphasis will be placed on advanced topics such as procedural guidance, regional anesthesia and management of the hypotensive patient, when compared to the 3rd year ultrasound elective.
Most of the rotation would be in the ED performing ultrasounds on patients. Some of the rotation may be spent shadowing staff ultrasound techs within the hospital. Students will learn a wide array of ultrasound exams Scanning shifts would be proctored by the emergency ultrasound faculty. The emergency ultrasound faculty consists of 3 ultrasound fellowship trained physicians and the chair of emergency medicine who wrote the first book on Ultrasonography in Trauma.
Monday: Watch modules on Knobology and Vascular Access before shift. 8 am to 12 pm scan shift.
1. Before scanning patients an orientation to the ultrasound and picture archiving system will be given.
2. The students will also be given an introductory lesson in ultrasound guided peripheral access using a phantom.
The orientation and vascular access lesson will take about 1 to 2 hours. The remainder of the shift will be spent scanning patients with EM faculty or sonographer.
Tuesday: Watch EFAST, RUSH and Abdominal Aortic Aneurysm modules before shift. 8 am to 12 pm Scan with EM faculty or Sonographer.
Wednesday: Watch Cardiac Widows, Left Ventricle Function and Right Heart Strain Modules before shift. 9 am to 1 pm scan with EM faculty or sonographer
Thursday: Watch Cardiac Tamponade, Lung Exam, B-Lines and Pleural Effusion Lectures. 10 am to 11 am image review with EM faculty. 12 pm to 3 pm scan with EM faculty or sonographer.
Friday: Day off
Saturday: Day off
Sunday: Watch Cellulitis, Abscess and Necrotizing Fasciitis Lectures. 3 pm to 7 pm scan with EM faculty
Monday: Watch Ocular Scanning Lectures. Scan 3 pm to 7 pm with EM faculty or sonographer
Tuesday: Watch Gallbladder and Small Bowel Obstruction Modules. 3 pm to 7 pm Scan with EM faculty or sonographer
Wednesday: Day off
Thursday: Watch Bladder Volume and Hydronephrosis Modules. 9 am to 11 am Image review with EM resident/faculty and 10 to 15 minute presentation given by med student. 11 am to 3 pm Scan with EM resident and/or faculty.
Friday: Day off
Saturday: Watch Deep Vein Thrombosis. Scan with EM faculty of sonographer 9 am to 3 pm
Sunday: Watch Fetal heart rate and estimating gestational age lectures. Scan with EM faculty 9 am to 3 pm

Type of students who would benefit from the course
This elective would be a great opportunity for those interested in ultrasound and its bedside applications or any student interested in any specialty. Education in Point of Care Ultrasound has become a requirement in Emergency Medicine but has application in almost every other specialty. Priority will be given to students intending to match into emergency medicine during the first 3 months of the academic year. We look forward to working with students interested in all specialties.

Weekly Schedule
  Clinical Activities (estimated schedule)  
Day of Week   AM   PM
Monday 8-12 (note information in description) 3-7 (note information in description)
Tuesday 8-12 (note information in description) 3-7 (note information in description)
Wednesday 9-1 (note information in description) off
Thursday 10-11 (note information in description) 11-3 (note information in description)
Friday Off Off
Saturday Off 9-3 (note information in description)
Sunday 9-3 (note information in description) 3-7 (note information in description)

 Average number of patients seen per week: 20-30
 Call Schedule: No

Research Activities (estimated schedule)
Activity Hours per Week
Faculty Contact-Time
Self-Directed Study

Method of Student Evaluation
1.  Clinical Observation
  A. Where are students observed on this elective?
    Inpatient Service   Ambulatory   Surgery   Standardized patients
Patients simulators   Other
  B. Frequency - How often are students observed clinically?
    Students will be observed scanning all patients throughout every shift
  C. Format - What method(s) are used to document the student's clinical performance?
    Daily oral feedback   End of period oral feedback   Written feedback

2.  Oral Presentation
  A. Audience - To whom does the student present?
    EM Ultrasound faculty and residents on EM ultrasound rotation
  B. Frequency / Duration of Presentation(s)?
    Each student will give two presentations during the 4-week block
  C. Format - What guidelines are set for the student's presentation?
    The presentations should be about 10 – 15 minutes in duration. The student may choose any POCUS topic of personal interest. The presentation should focus the fundamentals of a particular ultrasound topic including views to be obtained and pertinent positive and negative findings. The student may choose to focus on a specific patient that they have scanned during the week and how POCUS effected the patient's course.
  D. Assessment - Who assesses the student's presentation performance?
    Self-assessment   Peer assessment   Faculty assessment
  E. Method of content selection
    Current cases  Student-selected topic   Assigned topic

3.  Written Assignment (H&P's, notes, papers, abstracts, etc.)
  A. Frequency of written assignment(s)?
  B. Format - What guidelines are set for the student's written work?
  C. Length of written assignment(s)?
    Abstract   Annotated bibliography   1 - 2 page paper   3+ page paper
  D. Are recent references required?   No    If yes, how are they selected?
  E. Method of content selection - e.g. student-selected, relate to cases, etc.?
  F. Audience - Who assesses the student's written performance?
    Peer Assessment     Faculty Assessment     Other

4.  Examination
    Oral   Written multiple choice   Written essay / short answer   OSCE

5.  Extra Course Activities
  What expectations do you have for the student to demonstrate participation in the elective (e.g. small group activities, seminars, thoughtful questions, providing resources, journal club, resident lecture attendance)?
    Thoughtful questions and interaction during the scanning shifts. Demonstrating that they are familiarity with the online assignments.

6.  Additional Costs
  Please list any additional costs and/or purchases (books, materials, movies to watch, etc.) that are required for this course. Include an estimated total cost. If there are no additional costs, please enter "None".

7.  Other Modes of Evaluation
  Please explain below.
    Final evaluation/grade will be determined by EM faculty consensus. The student will be evaluated on perceived enthusiasm and improvement during the rotation.

8.  If this course is an Acting Internship, please complete the following:
  A. Objectives for the AI should relate directly to the Entrustable Professional Activities (EPAs). Each AI should describe how the four key Year-4 EPAs that our school has identified as being Year-4 skills are assessed. The Year-4 objectives are:
1. Entering and discussing orders/prescriptions.
2. Give or receive patient handover to transition care responsibility.
3. Recognizing a patient requiring urgent or emergent care and initiating management.
4. Obtaining informed consent for tests and procedures.
Specify how the student will be given formative feedback on their clinical skills.

Year-4 students should demonstrate mastery of EPAs they developed in the clerkship year, including recommending and interpreting common diagnostic and screening tests, and performing general procedures of a physician. They should be able to demonstrate masterfully and independently skills they mastered in Years 2-3, including efficiently performing comprehensive admission-notes and succinct daily progress notes and perform accurate, concise, and hypothesis-driven clinical presentations, form clinical questions and retrieve evidence to advance patient care. They should be able to demonstrate basic understanding of and beginning mastery of collaborate as a member of the interprofessional team and identify system failures and contribute to a culture of safety improvement.

List advanced clinical skills that a student will be assured an opportunity to practice.

How specifically will this AI build on developing skills from the clerkship year to prepare students for internship?

What opportunities will typically be available to all students who take this AI (procedures, required presentations, etc.)? What opportunities may be available based on patient load/presentation or student initiative (ie. Writing a case report)?

An AI should have expectation of a minimum of 32 hours per week of clinical responsibilities. Duty hours should be capped at ACGME limits for an intern, thus up to 24 hours followed by 4 hours of activities related to patient safety, education, and handoff. Students cannot work more than 80 hours per week averaged over 4 weeks. They can only have 1 day off in a 7-day work week with 8 hours off between shifts.

Clinical responsibilities will vary depending on specialty, but how is the student functioning with work commensurate to a PGY1 with an appropriate level of training?

How is the student demonstrating drawing clinical conclusions and/or developing a management plan and documentation as an intern would do?

How and by whom will midpoint feedback be provided to the student? How will you remediate deficiencies identified at midpoint?

Acting Internship students often seek letters of recommendation following their experience. How many different Faculty will work directly with the student and have knowledge of the student's abilities to detail in a written evaluation? Describe the degree of supervision and interaction with faculty vs. residents or other providers and how feedback will be obtained if more direct work is with residents or other providers.